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Impact of COVID-19 on Economic Trends in Oncology

AVBCC COVID-19 Webcast Series

Patients with cancer and cancer treatment dynamics continue to bounce back toward baseline as of late summer 2020, reported experts at the Association for Value-Based Cancer Care August 20 webcast, which focused on economic trends in cancer care during the COVID-19 pandemic.

After substantial declines that began in March 2020, in-person oncology visits for the last week in July reached 105.3% of the prepandemic baseline, new cancer diagnoses were at a 110.5% rate compared with baseline, and referrals to therapy or providers at a rate of 105.6% of baseline, reported Murray Aitken, MBA, MCom, Executive Director, IQVIA Institute for Human Data Science.

Furthermore, the weekly demand volume for cancer drugs was at 96% of baseline level overall; oral oncolytics were at 100.7% of baseline, and intravenous drugs at 96.6%. By contrast, telehealth visits peaked at approximately 10% of oncology in-office visits in late April and early May, and went further down to approximately 6% over the last weeks of August.

“The trend is fairly consistent in terms of some return to prepandemic baseline levels across these metrics,” Mr Aitken said. “In general, it looks as if we are returning to a level of activity that’s around or no more than 10% below prepandemic levels,” he said. “But what is clear is that we are not making up for all the disruption we saw earlier in the year. Even with the return to baseline level, we not seeing that backlog being cleared.”

Insurance Coverage

The issue of insurance coverage is of growing concern as high levels of unemployment persist, Mr Aitken said.

“We are tracking shifts in coverage related to retail prescriptions being filled, and those have shown no significant changes through June. Similarly, the level of patients moving in and out of commercial insurance so far has not been any greater than at this point in the prior year, but that is likely a reflection of people being put on furlough or otherwise maintaining insurance coverage. But changes here is something we will be watching for.”

Mr Aitken noted that so far, COVID-19 has not affected the oncology drug pipeline: as of August 2020, 11 new molecules had been approved by the FDA, just 1 less than in 2019.

“From an innovation perspective, we have seen no fundamental slowdown,” he said. “I think we will see more focus on the issues of disparities, access, and affordability as we go through the balance of the year and into 2021, which comes back to things like drug pricing, reimbursement levels, plan design, and sites of care delivery,” Mr Aitken observed.

Hospitals and Health Chains

Despite a dramatic reduction in spending, the United States continues to spend a high proportion of its gross domestic product on healthcare, said Bruce S. Pyenson, FSA, MAAA, Principal and Consulting Actuary, Milliman, New York, NY.

“And for-profit hospitals continue to do well,” Mr Pyenson noted, pointing out that chains such as HCA Healthcare and Tenet Health posted significant second-quarter profits despite the pandemic, and no significant widespread downgrades have been seen in not-for-profit hospital bonds.

“One of the reasons these hospitals have still been doing well is that they have variable costs. There were lots of layoffs, and purchases of supplies went down, so they were able to flex their expense side. The bailouts and the extra funding were also significant.”

Mr Pyenson predicted that COVID-19 will accelerate trends that began before the pandemic hit. For example, he noted, Genesis Healthcare—one of the nation’s largest postacute care chains, with hundreds of skilled nursing and other facilities across the country—has raised questions about whether it will be able to remain a going concern, after losing $67 million in revenue associated with COVID-19 during the second quarter of 2020.

“Postacute, long-term care is being downsized as people are more reluctant to see their parents in these facilities,” he said. “This will accelerate a long-term shift to getting people to age in the community.”

Physician Practices

Mr Pyenson also suggested that COVID would cause a permanent shift by providers and patients to choosing less aggressive courses of treatment, and that physician groups will find themselves more likely to consolidate with larger integrated delivery networks.

“These practices, including specialist groups, are not nearly as well capitalized as hospital organizations, and their capacity to deal with these changes has been limited.”

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